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Individual
DR. MARK WALL
Active
Individual
DR. MARK WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPA-4347
TX
101YP2500X
Professional Counselor
APA DIPLOMATE 4720
TX
101YP2500X
Professional Counselor
Primary
LPC 01604
TX
Other
Enumeration date
01/07/2008
Last updated
01/07/2008
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